12.6 Eczema and Acne

Question 1

Atopic Dermatitis (Eczema)

Answer 1

• Patches of skin become inflamed, itchy, red, patchy, and rough. Blisters can occur as well
• Triggered by a stressor on the body (stress, allergen, certain food like nuts or dairy)

Question 2

Infancy Dermatitis

Answer 2

Infancy
- Dry skin
- Redness
- Crust/Scales with erythematous vesicles and papules
- Cheeks, scalp, trunk and extremities
- Often symmetric
- Usually there is a family history of eczema, asthma, food allergies, or allergic rhinitis

• VERY ITCHY AND CAN CAUSE MORE LESIONS TO DEVELOP WHEN THEY ITCH

Question 3

Childhood Dermatitis

Answer 3

Childhood
- Starts at 2-3 years old
- Dry patches and papules
- Primarily on antecubital and popliteal areas, neck, and extremities
- Skin becomes hyperpigmented, thick and dry
- Keratosis Pilaris (chicken skin look)

Question 4

Atopic Dermatitis Interventions

Answer 4

• Moisturize frequently
• Tepid baths or emulsifying oil and emollient within 3 months of bathing (Aquaphor, Cetaphil, Dove, Mild Soap)
• Topical steroids applied before moisturizer (use sparingly)
• Immunomodulators (tacrolimus/pimecrolimus) at the start of exacerbations)
• Oral antihistamines PRN (to help with itching/scratching)
• DO NOT USE BUBBLE BATHS OR FABRIC SOFTNER BECAUSE THESE CAN IRRITATE SKIN

Prevention of Infection
- Short fingernails
- Intense pruritis use colloid baths, wet compress, cool humidifiers

Itching/Sleep Disturbances
- Topical steroids, frequent moisturizer
- NO CURE FOR ECZEMA (TREATMENT AIMS TO HEAL AFFECTED AREAS OF SKIN AND PREVENTING FLAIR UPS)

Question 5

Acne

Answer 5

• Increased sebum production on skin and abnormal follicular shedding of skin cells that are more adherent than normal
• Overgrowth of bacteria in the hair follicles
• Keratin and sebum block follicular canal’s causing comedones (whiteheads and blackheads)

Question 6

Acne Treatment

Answer 6

• Typically develops in teenage population
• Peer group is important so face full of acne can make them feel self-conscious. Provide education that they are not a dirty person if they have acne.
• Teach them to clean their skin 1-2 times a day with mild soap.
• Teach them not to pop, pick, or squeeze pimples because it can introduce more bacteria to skin and scarring.

Medications
- Tretinoin - Interrupts abnormal keratinization which lessens desquamation (apply after washing face at night) - Can cause photosensitivity (sunscreen)
- Benzyl Peroxide - Antibacterial (this can bleach their clothes/linen if it gets on those materials)
- Topical/Oral Antibiotics (can cause skin irritation but you can use it every other day to lessen irritation)
- Isotretinoin (Accutane) - Used when other treatment has not worked due to side effects (can cause suicide ideation, affect liver function, cholesterol and triglycerides. It is also a TERATOGEN) - Patients need to be on oral contraceptives and use 2 forms of birth control and regular pregnancy tests due to medication being a teratogen.